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If you are a provider affiliated with one of Credentialing Corporation's clients,
you may complete your credentialing or recredentialing application on line
and submit most of the information electronically.
This website is secure and the information you send
will be treated as confidential information.
The following data entry process walks you through the application.
When you have completed the data entry you may
view the completed form for quality review purposes.
Those fields that are mandatory to complete are highlighted in
red.
Fields that may be applicable to a specific profession are highlighted in
green.
If you have multiple offices you may complete multiple versions of Section III.
You may complete Section IX on-line or you may submit
written descriptions with your other paper attachments.
When you have completed the data entry function
and you have reviewed the information to assure that it is correct and complete,
you may print a copy of the applications for your records if you wish.
It is required that you print the attestation and signature page,
sign and date it, and mail or fax it to Credentialing Corporation
at the address listed below with the required attachments.
Attachments must include a copy of a DEA (if applicable to your specialty),
a copy of your current malpractice face sheet,
and any malpractice history explanations if not completed on-line.
Your application will be considered received on the date that
Credentialing Corporation receives the mailed or faxed attestation.
If you have any questions about the on-line application process, or if you're interested
in receiving information on CCA,
you may contact us at (440) 895-1900.
Please mail the paper attestation and attachments to:
Credentialing Corporation of America, Inc.
20800 Center Ridge Rd. Suite 312
Rocky River, OH 44116-4307
Fax (440) 895-1901
Your internet browser may have a "time-out" limitation on it. Please
complete and send this application with one hour of starting it,
otherwise some data may be lost before it is sent to us.
When completing the cover page on line,
it is required that you complete the line titled "MCO or Group Name"
with the name of the organization for whom you wish to be credentialed.
Without the name of the CCA Client, CCA will not be able to direct your application accurately.
Please note: In order for CCA to process your application all application attachments and
the provider attestation page will need to be mailed or faxed directly to CCA at the address
listed above. By filling out your application online, the application will be immediately
sent electronically to CCA, however, it will not be considered received until we are in
receipt of all application attachments and the attestation page.
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